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Relations Between Performance and Subjective Ratings of Sleepiness During a Night Awake
Abstract
The present study validated the nine-point Karolinska Sleepiness Scale (KSS) and the new Accumulated Time with Sleepiness (ATS) scale against performance of laboratory tasks. The ATS scale was designed as a method for integrating subjective sleepiness over longer time periods. The subjects were asked if certain symptoms of sleepiness had occurred and, if so, for how long. Six subjects participated twice. Each time they were kept awake during the night (except for a short nap occurring during one of the nights in a counterbalanced order) and were tested at 2200, 0200, 0400 and 0600 hours. The tests included a 10-minute rest period, a 28-minute visual vigilance task and an 11-minute single reaction time task. KSS and visual analogue scale (VAS) ratings were given before each test, and ATS ratings were given after. Performance deteriorated clearly, and all three rating scales reflected increased sleepiness with time of night. Scores on the KSS and VAS showed high correlations with performance tasks (mean intraindividual correlations were between 0.49 and 0.71). Performance correlated even higher with the ATS ratings (r = 0.73-0.79). Intercorrelations between rating scales were also high (r = 0.65-0.86). It was concluded that there were strong relations between ratings of sleepiness and performance, that the ATS rating scale was at least as good as the other scales and that the ratings were affected by type of task.
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“The KSS is a 9-point Likert scale with all numbers having valid point values, but only the odd numbers have descriptions: 1 representing ' extremely alert, ' 3 representing ' alert, ' 5 representing ' neither alert nor sleepy, ' and 9 representing ' extremely sleepy ' (9, 41).”
From Evening use of light-emitting eReaders negatively affects sleep, circadian timing, and next-morning alertness. (2015) · cites this paper as [41]
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“, 1973) and Karolinska Sleepiness Scale (KSS; (Gillberg et al., 1994) were administered before and after sleep to assess sleepiness.”
MethodPhilip, P., Taillard, J., Quera-Salva, M.-A., Bioulac, B. H., & Åkerstedt, T. (1999) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1999.00127.x · Cited by 118
Self-citationAltered sleep/wake patterns and mental performance
Åkerstedt, T. (2006) · Physiology & Behavior · doi:10.1016/j.physbeh.2006.09.007 · Cited by 126
Self-citationSubjective sleepiness and accident risk avoiding the ecological fallacy
Ingre, M., Åkerstedt, T., Peters, B., Anund, A., Kecklund, G., & Pickles, A. R. (2006) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2006.00517.x · Cited by 116
Self-citationSilva, E. J., Wang, W., Ronda, J. M., Wyatt, J. K., & Duffy, J. F. (2010) · Sleep · doi:10.1093/sleep/33.4.481 · Cited by 114
Adenosine, Caffeine, and Performance: From Cognitive Neuroscience of Sleep to Sleep Pharmacogenetics
Urry, E., & Landolt, H. (2014) · Current topics in behavioral neurosciences · doi:10.1007/7854_2014_274 · Cited by 117
“For example, research incorporating a 40-hour constant routine protocol revealed a clear circadian modulation of subjective sleepiness (Karolinska Sleepiness Scale) (Gillberg et al. 1994) and cognitive performance (psychomotor vigilance task [PVT]) (Dinges and Powell 1985), even in the absence of strong homeostatic sl…”
MethodInfluentialZhou, X., Ferguson, S. A., Matthews, R. W., Sargent, C., Darwent, D., Kennaway, D. J., & Roach, G. D. (2011) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2011.00924.x · Cited by 111
Bjorvatn, B., Stangenes, K. M., Øyane, N., Forberg, K., Löwden, A., Holsten, F., & Åkerstedt, T. (2006) · SLEEP · doi:10.1093/sleep/29.6.821 · Cited by 108
Self-citationDingus, T. A., Neale, V. L., Klauer, S. G., Petersen, A., & Carroll, R. J. (2006) · Accident Analysis & Prevention · doi:10.1016/j.aap.2006.05.001 · Cited by 103
The impact of a week of simulated night work on sleep, circadian phase, and performance
Lamond, N., Dorrian, J., Roach, G. D., McCulloch, K. M., Holmes, A. L., Burgess, H. J., Fletcher, A., & Dawson, D. E. (2003) · Occupational and Environmental Medicine · doi:10.1136/oem.60.11.e13 · Cited by 101
Sleep deprivation increases the costs of attentional effort: Performance, preference and pupil size
Massar, S. A. A., Lim, J., Sasmita, K., & Chee, M. W. L. (2018) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2018.03.032 · Cited by 99
“Throughout the SD night participants performed hourly vigilance test (grad-CPT; Esterman et al., 2013) and sleepiness ratings (Karolinksa Sleepiness Scale; Gillberg et al., 1994).”
Portable Drowsiness Detection through Use of a Prefrontal Single-Channel Electroencephalogram
Ogino, M., & Mitsukura, Y. (2018) · Sensors · doi:10.3390/s18124477 · Cited by 96
Leproult, R., Reeth, O. V., Byrne, M. M., Sturis, J., & Cauter, E. V. (1997) · Journal of Biological Rhythms · doi:10.1177/074873049701200306 · Cited by 94
Is Sleep per se a Zeitgeber in Humans?
Danilenko, K. V., Cajochen, C., & Wirz‐Justice, A. (2003) · Journal of Biological Rhythms · doi:10.1177/0748730403251732 · Cited by 92
“In both CR protocols, subjective estimates of sleepiness were assessed at 30-min intervals using the Karolinska Sleepiness Scale (Gillberg et al., 1994), together with 2 visual analog scales for energy and mood.”
MethodA 30-Minute, but Not a 10-Minute Nighttime Nap is Associated with Sleep Inertia
Hilditch, C. J., Centofanti, S. A., Dorrian, J., & Banks, S. (2016) · SLEEP · doi:10.5665/sleep.5550 · Cited by 90
Arnardóttir, E. S., Nikonova, E. V., Shockley, K. R., Podtelezhnikov, A. A., Anafi, R. C., Tanis, K. Q., Maislin, G., Stone, D. J., Renger, J. J., Winrow, C. J., et al. (2014) · SLEEP · doi:10.5665/sleep.4064 · Cited by 87
D'Rozario, A. L., Cross, N. E., Vakulin, A., Bartlett, D. J., WONG, K. K. H., Wang, D., & Grunstein, R. R. (2016) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2016.10.003 · Cited by 92
“circadian timing, and these correspond with changes in cognitive processing [22, 27, 28].”
BackgroundAlerting, orienting and executive control: the effects of sleep deprivation on attentional networks
Martella, D., Casagrande, M., & Lupiáñez, J. (2011) · Experimental Brain Research · doi:10.1007/s00221-011-2605-3 · Cited by 91
“Sleep loss increases sleepiness (Carskadon and Dement 1979; Gillberg et al. 1994) and negatively aVects performance on cognitive tasks (e.”
BackgroundSatterfield, B. C., & Dongen, H. P. A. V. (2013) · Fatigue Biomedicine Health & Behavior · doi:10.1080/21641846.2013.798923 · Cited by 88
“There is some (anecdotal) evidence that self- and peer-monitoring and other informal “fatigue proofing” procedures can be effective for detecting and managing fatigue,[111] especially when individuals are reminded to pay attention to specific symptoms such as heavy eyelids or the effort required to fight sleep.[112] H…”
BackgroundRajaratnam, S. M. W., Dijk, D., Middleton, B., Stone, B. M., & Arendt, J. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2003-030460 · Cited by 86
Lee, H.-A., Cho, C., & Kim, L. (2014) · Sleep Medicine and Psychophysiology · doi:10.14401/kasmed.2014.21.2.51 · Cited by 86
Wyatt, J. K., Stepanski, E. J., & Kirkby, J. (2006) · SLEEP · doi:10.1093/sleep/29.8.1075 · Cited by 85
Philip, P., Sagaspe, P., Prague, M., Tassi, P., Capelli, A., Bioulac, B., Commenges, D., & Taillard, J. (2012) · SLEEP · doi:10.5665/sleep.1968 · Cited by 84
Bjorvatn, B., Stangenes, K. M., Øyane, N., Forberg, K., Löwden, A., Holsten, F., & Åkerstedt, T. (2007) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.1129 · Cited by 84
Self-citationBjorvatn, B., Kecklund, G., & Åkerstedt, T. (1999) · Journal of Sleep Research · doi:10.1046/j.1365-2869.1999.00146.x · Cited by 83
“Subjective ratings The Karolinska Sleepiness Scale (KSS; Åkerstedt and Gillberg RESULTS 1990) and the Accumulated Time with Sleepiness (ATS; Gillberg et al. 1994) were used to obtain ratings of sleepiness.”
MethodResultSelf-citationGonzález, J. L., Jiménez, B. M., Garrosa, E., & López‐López, A. (2005) · International Journal of Industrial Ergonomics · doi:10.1016/j.ergon.2005.02.007 · Cited by 82
“The qualitative aspects of fatigue most frequently described have been physical fatigue and mental fatigue (Chalder et al., 1993; Grandjean, 1979), while other aspects of the construct usually studied are sleepiness (Gillberg et al., 1994) and discomfort (Cameron, 1996).”
BackgroundShiftwork and different dimensions of fatigue
Åhsberg, E., Kecklund, G., Åkerstedt, T., & Gamberale, F. (2000) · International Journal of Industrial Ergonomics · doi:10.1016/s0169-8141(00)00007-x · Cited by 80
Self-citationSpecific sleepiness symptoms are indicators of performance impairment during sleep deprivation
Howard, M. E., Jackson, M. L., Berlowitz, D. J., O’Donoghue, F. J., Swann, P., Westlake, J., Wilkinson, V. E., & Pierce, R. J. (2013) · Accident Analysis & Prevention · doi:10.1016/j.aap.2013.09.003 · Cited by 78
Sagaspe, P., Taillard, J., Amieva, H., Beck, A., Rascol, O., Dartigues, J., Capelli, A., & Philip, P. (2012) · PLoS ONE · doi:10.1371/journal.pone.0039410 · Cited by 83
“A 10-min simple reaction time test (SRTT) on a PALM personal organizer [55] was performed to evaluate sustained attention.”
Åkerstedt, T. (1995) · Neurophysiologie Clinique · doi:10.1016/0987-7053(96)84910-0 · Cited by 84
Self-citationPhipps‐Nelson, J., Redman, J. R., & Rajaratnam, S. M. W. (2010) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2010.00900.x · Cited by 77
“Following each driving session, participants also performed the PVT (duration 10 min; Dinges et al., 1997; Kribbs and Dinges, 1994) and the Karolinska Drowsiness Test (KDT; duration 5 min; Åkerstedt and Gillberg, 1990; Gillberg et al., 1994).”
BackgroundMethodPerformance vigilance task and sleepiness in patients with sleep-disordered breathing
Sforza, E., Haba‐Rubio, J., de Bilbao, F., Rochat, T., & Ibanez, V. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00091903 · Cited by 75
Kaida, K., Åkerstedt, T., Kecklund, G., Nilsson, J., & Axelsson, J. (2007) · Industrial Health · doi:10.2486/indhealth.45.520 · Cited by 75
Self-citationPerformance on a Simple Reaction Time Task While Sleep Deprived
van den Berg, J., & Neely, G. (2006) · Perceptual and Motor Skills · doi:10.2466/pms.102.2.589-599 · Cited by 74
Paavilainen, P., Korhonen, I., Lötjönen, J. M. P., Cluitmans, L., Jylhä, M. K., Särelä, A., & Partinen, M. (2005) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2004.00433.x · Cited by 73
Gander, P. H., Signal, T. L., van den Berg, M. J., Mulrine, H. M., Jay, S. M., & Jim Mangie, C. (2013) · Journal of Sleep Research · doi:10.1111/jsr.12071 · Cited by 73
Putilov, A. A., & Donskaya, O. G. (2013) · Clinical Neurophysiology · doi:10.1016/j.clinph.2013.01.018 · Cited by 70
“In fact, each EEG recording session might be regarded as a modified Karolinska drowsiness test (Åkerstedt and Gillberg, 1990; Gillberg et al., 1994) that, however, originally required 5-min rather than 2-min interval of eyes open recording.”
Metadata
- Authors
- Gillberg, M., Kecklund, G., & Åkerstedt, T.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Gillberg, Mats
- Venue
- Sleep
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-05
- Volume
- 17
- Issue
- 3
- Pages
- 236-241
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- OpenAlex
- W254030361
- Cited by
- 423
- References
- 0
- Citations by year
- 2026: 10 · 2025: 5 · 2024: 12 · 2023: 9 · 2022: 12 · 2021: 12 · 2020: 9 · 2019: 13 · 2018: 16 · 2017: 11 · 2016: 16 · 2015: 16 · 2014: 18 · 2013: 22 · 2012: 18
- FWCI
- 6.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- SLEEP (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Mind wandering and attention
- Keywords
- sleepiness, Karolinska Sleepiness Scale, visual vigilance task, reaction time, sleep deprivation, scale validation, visual analogue scale, performance degradation
- MeSH terms
- Adult, Arousal, Female, Humans, Male, Middle Aged, Self-Assessment, Sleep Deprivation, Task Performance and Analysis, Wakefulness
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